Axial Spondyloarthritis

Axial Spondyloarthritis is a chronic inflammatory condition targeting the sacroiliac joints and the spine. It typically starts in the late teens and early 20’s but can present up to 45 years of age. It has been estimated that AxSpA accounts for <5% of chronic back pain.

History

Back pain > 3months with onset <45yrs of age
Does not improve on resting
Insidious onset
Pain at night improving on rising
Early morning stiffness improving with exercise
Good response to NSAID

Associated features

History of iritis or uveitis
History of psoriasis
History of inflammatory bowel disease

Positive family history of AxSpA
Peripheral large joint synovitis
Heel pain (enthesitis)
Buttock pain alternating with back pain
Dactylitis of fingers or toes

Examination

Reduced range of spine movements

Peripheral joint examination for synovitis

M.A. & S.R/H.B. 12-08-24

Please see primary care management section.

Refer to the rheumatology if the patient has five of the following six features of inflammatory back pain OR fourof the six and at least one additional feature of AxSpA:

Features of inflammatory back pain

Duration >3 months, onset aged <45 years
Does not improve on resting
Insidious onset
Pain at night improves on rising.
Early morning stiffness improving with exercise
Good response to NSAID

Additional features of AxSpA

A history of uveitis / iritis
Heel pain suggestive if enthesitis
Clinical evidence of peripheral arthritis
Clinical evidence of dactylitis
A history of psoriasis
A history of inflammatory bowel disease
A raised CRP or ESR
Buttock pain alternating with back pain
A family history of AxSpA, inflammatory bowel disease, reactive arthritis, psoriasis or uveitis.

How to refer:

Please refer using SCIgw > WGH> Rheumatology> Axial Spondyloarthritis
Please summarise in your referral which of the above clinical features of AxSpA the patient had presented with.
Take blood for U&E, LFT, FBC and CRP

What happens next?

Your referral will be reviewed by a triage consultant and checked for completeness. If the criteria are met, you and the patient will get a letter to indicate that a MRI scan has been requested
When the results are through you will get a further letter indicating whether the patient will be offered a face to face follow up at rheumatology (if there is evidence of AxSpA) or if they are being discharged to primary care (where there is no evidence of AxSpA)

Investigations